Loading...
HomeMy WebLinkAbout720 Arbor Ave - Applications/Water Heater - 11/20/2015401 N. k_uueye Hve V.U. tiox �iSu Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-2-COUNTER PERMITS ONLY This application. is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log l7 Heating U It ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and manufacturer) Complete al applicable information on the application. Incomplete applications will not be accepted. Application # B1508662 For office use only Date -Job Site AdAress (raquired), Value of Construction (labor; materials, profit) a0 perry Owner Name Address City/State Zip Phone Joul b - 053 Applicant Nam Address City/State Zip rl Phone qT®• yg • qd t/! . ntractor Address A0//1"' City/State Zip Phone e Contractor City of Ft. Collins Safes Tax # Are .you paying taxes here or by report? ❑J HereJO-Report saiestax nunberisraquiredbyall con tractor. lD0!© Are you paying with your trust account?p,Yes ❑ No Is this a residential or commercial project? -_k�8esi ential ❑ Commercial If residential, is it: ❑ Single Family Detacfified Condo/townhome (single family attached) ❑ Duplex El Multifamily (apartment) ❑ Garage If commercial, Is it: ❑ Bank ❑ Bar ❑. Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 5o years of age or more? ❑ Yes ❑ No Ifyes, youmayneed to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? If prior to 1975, you will need an asbestos assessment to submit with this application. Description of work *If lawn sprinkler/backFlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician. subcontractors: List the company name or City of Collins license # Electrician Plumber Mechanical Roofer Other I hereby acknowledge that.I have read this application and state that the above information is complete and correct. I agree to comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a permit is not valid until it has been paid and issued. Applicant:' Print Name: i�l Y'1 I -Signature S1 JDate ll— ao-15-